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ANNUAL FEE and REPORT REOUEST <br />Y <br />PERMITTEE NAME: Montezuma County <br />PERMIT NO.: M-1978-107 c/ <br />OPERATION NAME: Tozer Pit <br />ANNIVERSARY DATE: November 2, 2009 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Montezuma <br /> <br /> <br /> <br />M 9*9 <br />OCT 19 2009 <br />Division Of R-,clMation, <br />kliniqn and Safety <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an <br />operator shall submit the annual feeLa peport and map showing the_ extent-ofcwxeat disturbances-to -affected - - <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual report may to this form The Annual <br />Report & Fee requirement is not met until we have received the following components:fee, report, and <br />associated map. If no new disturbances or reclamation have occurred Burin the previous Year and no <br />new changes to the previous year's map are necessary, then no new map is required, provided that the <br />Operator shall state this in the Annual Report Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Lloyd Everett <br />Permittee Name: Montezuma County <br />Address: 1680 rth H ay 1? 45 <br />Cortez, CO 81321 <br /> <br />Phone Number: (970) 565-8666 <br />Fax Number: (970) 565-8252 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are <br />enc.( ed. ,,` 'pI?-? C? N L ? @ tC_ -?- a V u ? i FBI ?. od <br />A -- <br />ign ture o Corporate Officer, Owner, or Designee <br />Date I CD /'&/o ? <br />M:\PERMITVv1AS7'ERDOCUI EN SIM-AF-04